Imagine you’re a single mother working a minimum wage job, and you are diagnosed with type 2 diabetes. Minimum wage is certainly not a living wage, and the kinds of food that one can afford working $10.25 per hour are limited, especially if you’re supporting yourself and your children. The more nutritious food you can afford to purchase will typically go to feeding your kids first, and you will have whatever is left. You rely on food hampers to ease the financial burden of buying food, but you can’t rely on them being filled with the options you need to manage your diabetes. What’s more, the current situation and stress of living on low-income while raising a family takes precedence over getting support to manage living with diabetes. It’s nearly impossible to make specialist appointments because of your work schedule and your kids’ school schedule, and bus fare can add up quickly.
Something we are constantly thinking about at the Emergency Food Hamper program is how we can better accommodate people’s dietary needs, whether they are for medical, religious, or other reasons. One common disease that affects many of our patrons is type 2 diabetes. As you can see from the example at the beginning of this post, people’s income level very heavily determines their level of health (for more on the social determinants of health, read Matt’s blog post here). This is particularly true of diabetes; in 2010, Statistics Canada found that women living on low income were more likely than their more privileged counterparts to develop the disease (read a news article on this here, and the actual report from Statistics Canada here). On top of this, the complications of living with diabetes are much harder to manage if you are living on low income. Because we try to provide the best nutrition options for people who come in for hampers, we have to pay attention to how diabetes affects people living on low income and try to accommodate that as best we can.
So…what exactly is diabetes?
Before talking about the links between living on low income and diabetes, let me explain the basics. Type 2 diabetes is characterized by a lack of insulin in the bloodstream, or the body not using that insulin effectively. Insulin is a hormone produced by the pancreas that allows glucose (sugar) to enter cells in the blood stream and be used by the body for energy. Without insulin (or if insulin isn’t working properly), glucose builds up, unused, in the bloodstream. This can result in long-term complications like blindness, kidney problems, and nerve damage. The long-term complications of diabetes can be managed by keeping glucose levels down through eating foods that are low in sugar and white flour, exercising, not smoking, and managing stress.
Ursula, a regular volunteer here at the Food Hamper program, has been living with diabetes for about 10 years. Talking to me about it, she said “when your sugar is down you feel nauseous and shaky, when its high you feel unsettled and then you have to go for walks or exercise to work your sugar off.” She also said “never skip a meal when you’re diabetic, your sugar goes down.” In the short term, these effects can be uncomfortable. It can be hard under any circumstances to stick to a strict nutrition routine in order to manage your sugar levels.
Managing diabetes on low income
For people living on low income, diabetes becomes particularly difficult to manage. For one thing, insulin and glucose testing strips can be expensive if you don’t have benefits. In a 2010 study on people living with diabetes on low income in Canada (which can be found here), one participant was quoted as saying “sometimes I don’t take the medicine every day, because the medicine is expensive and my husband is not working, and because it is not the only medicine that I have to take, so I try to make it last.” Too often, people need to choose between monitoring their glucose and paying their rent or feeding their family.
While medication is important, type 2 diabetes can be managed by eating a healthy diet and exercising regularly. In many cases there can be high costs associated with each; healthy foods tend to cost more than less healthy options, and things like gym memberships and running shoes can sure set people back. In addition, if someone is relying on soup kitchens and food hampers for their meals, they often don’t have much control over what they can eat.
Another factor that makes diabetes hard to manage is simply the priority people attribute to it; often serious short term problems must be dealt with before someone deals with diabetes. For example, if someone is dealing with issues like homelessness or addiction, dealing with diabetes to limit long-term complications becomes a secondary concern. Type 2 diabetes is a progressive disease, meaning it gets more serious over time, especially if it is not managed. The unfortunate truth is that if someone puts off dealing with the disease complications may set in much more quickly.
On top of all of this, long-term diabetes complications are exacerbated by stress. Stress promotes the release of glucose in the blood stream, which is exactly what people with diabetes need to avoid. Many people living on low income deal with high levels of financial or other stress over the long term. This means that in a cruel twist of fate, simply the stress of having diabetes can make the disease significantly worse. Someone living on low-income who has diabetes was quoted as saying “I look which [food] is cheaper because my money is very small, so after giving rent, I just have little bit money…Sometimes after the 20th of the month my money finished. It’s very tight.” It’s incredibly stressful to try and manage money while attempting to feed yourself and your children nutritious food. Often parents will feed their children before feeding themselves, which creates stress because they often are aware they are not managing their disease as they should be.
The Emergency Food Hamper’s role
So, seeing as nutrition is an important key to managing diabetes, how can we help? One way we try to help is through packing a healthier hamper. We try to switch out white pasta and bread for whole wheat versions, limit the amount of sugar by giving healthier cereals and real fruit juice, and give less processed and more whole foods.
There are also quite a few community resources to which we can refer people if they’re interested. There are a lot of educational programs that are free for people who have diabetes, and can help them set goals for nutrition and exercise. The Kitchener Downtown Community Health Centre has a diabetes program where they take a comprehensive approach to helping people manage the disease. They have a social worker, exercise classes, and a nutritionist right on site. This approach to helping people with the medical side as well as helping them manage diabetes in their day to day life is a very important step; it’s a more holistic view of health and wellbeing which is important to treating diabetes.
Nutrition is just one—albeit an important—piece of the puzzle, but it is one we try to make as easy to manage as possible. At the end of the day there are many other factors which put people living with diabetes on low income at a tremendous disadvantage, and many of these factors don’t have to do with their individual lifestyle, but with the economic and political systems in which they live. The least we can do is help them regain some control over what they put in their bodies.